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Hepatitis Scotland e-Bulletin July 2015

Welcome to the latest edition of the Hepatitis Scotland e-Bulletin.

World Hepatitis Day in Scotland 2015

World Hepatitis Day takes place on Tuesday July 28th and once again there is a wide range of activity taking place across Scotland.

The HepCScot campaign will once again be at the forefront of events and activity, with bus side ads appearing in Glasgow for the third year running bearing the Big Red C and ‘Ever injected? Get tested’ message. Activity will continue until the World Hepatitis Summit which takes place in Glasgow from September 2nd to September 4th.

Relaunch of the #EweAtRisk Hep C animation on Youtube and other social media channels, now with testing message

You can keep up to date with events and activity by viewing the Hepatitis Scotland events calendar and keep tabs on the HepCScot.org.uk website for upcoming developments.

New test uses single drop of blood to give entire viral infection history

Researchers have developed a cheap and rapid test which could transform the detection of serious infections such as Hepatitis C and HIV. The new test is capable of revealing a person’s full history of viral infections from a single drop of blood, including infections they may currently have but be unaware of due to lack of symptoms.Further discussion here.

Hepatitis C Course: Enhancing Prevention, Testing and Care

RCGP have developed a free online Hepatitis C training course aimed at staff working in drug services and those who work with drug users to improve knowledge and awareness of the virus. It takes 2 hours to complete and participants can print a CDP certificate at the end.

In response to the potentially emerging issue of chemsex among gay and bi-sexual men in Scotland, Hepatitis Scoltand has been working with a variety of third sector, private and statutory partners, to organise events across the country aimed at both professionals and gay and bi-sexual men (and MSM).

The 'Play Hard, Stay Safe' campaign seeks to increase awareness of the risks involved in chemsex or other more risky kinds of sex, whilst maintaining a sex positive focus. The events will cover such topics as Hepatitis C/HIV co-infection, safer injecting practices, new psychoactive substances and sexual practices.

BBC also recently aired a program on Radfio 4 "Chemsex and it's impact on Public Health". Available on iplayer.

Gay Men’s Health, in partnership with NHS Lothian and Waverley Care, are conducting an anonymous online survey on chemsex. If you sometimes use drugs/chems for sex, they would like to hear from you.

NHS Greater Glasgow and Clyde issue HIV warning

NHS Greater Glasgow and Clyde Public Health officials have issued a warning to all those who are injecting drugs to protect themselves and those around them as the number of new HIV infections in this risk group have increased significantly since last year.

There are on average 115 new cases of HIV in Greater Glasgow and Clyde each year, the majority being sexually transmitted. The number of cases thought to be transmitted through injection drug use is on average ten new cases per year, but by the middle of June therehas been 17 cases so far.

The number of new HIV infections in people who have a history of injecting drugs in 2015 has already exceeded the total of new infections for the whole of 2014.

Ireland sees substantial rise in HIV cases among gay men and PWID

The Health Service Executive in Ireland has also just published a surveillance report on HIV in Ireland for Irish AIDs day. It reports that new HIV cases in Ireland are at their highest for 5 years, with a record number of infections in gay men and a major increase among people who inject drugs. Overall there was an 11% increase in new HIV infections compared with 2013.

Hepatitis C drug updates: Abbvie get go ahead in Scotland

The Scottish Medicines Consortium has approved two new treatments for Hepatitis C for use in Scotland. Both are produced by the pharmaceutical company Abbvie. Viekirax (a single pill combining ombitasvir, paritaprevir and ritonovir) and Exviera (dasabuvir) are approved for genotypes 1 and 4.

Depending on genotype Viekirax will be prescribed with Exviera, with or without ribavirin, or alternatively the same combination minus Exviera. In clinical trials these treatments have shown SVR rates at week 12 of 96% and above.

NHS England gives new treatments the go ahead

NHS England will now potentially make interferon-free treatments available to Hepatitis C patients with cirrhosis after a 6 month delay due to cost considerations. Around 3,500 patients in England and Wales are expected to gain access to Gilead’s Harvoni and Abbvie’s Viekiera Pak.

AASLD updates guidance on use of Hep C drugs

The American Association for the Study of Liver Disease has updated it's guidance on the use of Hepatitis C drugs. Original consensus recommendations included:

Two US patient advocacy groups are suing the US FDA, claiming that they failed to release trial data pertinent to Gilead's Sovaldi (sofosbuvir) and Harvoni treatments on a timely basis. They are concerned that the accelarated review process under which both drugs were granted approval may increase the risk that gaps in drug efficacy will go undiscovered, or that side effects or contraindications with other drugs will go unnoticed, arguing that researchers are unable to independently analyse these issues. They argue that given the high cost of these drugs and their widespread use, it is essential to have this independently verified data in order to evaluate cost effectiveness.

Gel may reduce number of interferon injections

Researchers have developed a drug delivering hydrogel which prevents premature release of drugs into the body, allowing for longer term drug delivery and less side effects. The gel could be used in Hepatitis C patients being treated with interferon containing regimens and reduce the frequency of injections whilst increasing the therapeutic efficiency of the drug.

Fancy an Indian summer?

Medical tourism

In response to the high price of Hep C drugs, some people are searching forcreative means of procuring the drug in countries such as India, where it is sold for as little as $900 per course, with some US patients flying out to buy the treatment there. Indeed some companies are putting together medical tourism packages, and building networks of foreign doctors and hospitals willing to prescribe Hep C drugs to US patients.

Saving or stigmatising?

The UK Health Secretary Jeremy Hunt has announced UK government plans to label prescriptions costing more than £20 with how much they cost and the words 'funded by the UK taxpayer'. The government say this is aimed at reducing the £300million bill for wasted medications and improving adherence to drugs. However, questions have been raised by some about how useful this will actually be in reducing waste - and whether or not this may further stigmatise people who may be living with long term conditions such as HIV and Hepatitis C by making them feel guilty or a burden to others.

Debating the issue on Question Time, Labour leadership contender Jeremy Corbyn suggested that real savings in the NHS would only be found by increasing pressure on big pharma to reduce drug prices, the NHS using legislation to dispense generic medications where possible and by the NHS becoming more involved in drug research and production.

If only there was some more money.....

Cost was cited as a reason for the delayed implementation of NICE guidance on sofosbuvir earlier this year by NHS England, and the need to make savings is given for the rationale for labeling prescriptions.

In the meantime Amazon paid just £11.9million in UK tax last year, while the online retailer's Luxembourg took £5.3billion from British internet shoppers and only registering a profit of just over £34million in the UK.

Methadone programmes protect against HIV infection

A recent study published in Drug and Alcohol Findings has added weight to the conclusion that methadone maintenance programmes protect dependent opiate injectors against HIV infection, and that the evidence in their favour is more convincing than for other types of treatment. The study was the first to synthesise all the relevant evidence.

Surge in HIV and hepatitis cases tests US policy on needle exchange

With Indiana in the grip of an HIV epidemic which has forced it’s Republican governor to allow needle exchange programmes in the state, and HIV and hepatitis transmissions rising in other states, this New York Times article examines the politics of needle exchange in the US.

Prisoners forced to withdraw from methadone less likely to seek community treatment

The results of a randomised controlled trial published in lancet found that prisoners who were receiving methadone on release were 7 times more likely to seek community based treatment within a month following release from prison than those not receiving methadone. Those not receiving methadone upon release were more likely to delay seeking community treatment, or to drop out of treatment altogether.

'Brewing Up a Perfect Storm' conference round up

Our recent 'Alcohol, Drugs and Hepatitis C' conference, in partnership with Scottish Health Action on Alcohol (SHAAP) took place on June 24th in Edinburgh and was a great success. Over 100 people attended from drug, alcohol and hepatitis services across the UK to hear from speakers including Dr. Michael Schwarzinger of the Translational Health Economics Network in Paris.

Notable points made during the conference included:

- 36% of HCV cirrhosis cases in Scotland would not have occurred in the absence of alcohol- 33% of individuals in HCV specialist care in Scotland have ever reported alcohol use of more than 50 units per week- Evidence of alcohol's role in HCV patient cirrhosis is not yet being translated into any significant public health action- Alcohol use can confound cost effectiveness models of new direct acting anti-virals (Dr. Schwarzinger)- 'Scotland badly needs minimum unit pricing' (Dr. Iain Smith, SHAAP)

Statins reduce risk of liver decompensation and death in patients with cirrhosis

Research presented at EASL’s Liver Congress 2015 showed that using statins to control blood cholesterol in people with Hepatitis C led to a significantly reduced risk of decompensated disease and were less likely to die.

Hepatitis B vaccine less effective for Coeliac patients

A new Spanish study has provided strong evidence that the Hepatitis B vaccine may not fully protect children with the autoimmune disorder Coeliac, a condition where the small intestine becomes damaged by gluten. Celiac affects about 1 in 100 people worldwide.

Drug prevents Hep B transmission during pregnancy

A study published in the Clinical Journal of Gastroenterology and Hepatology has shown that the anti viral drug telbivudine significantly reduces transmission of Hepatitis B from mother to baby during pregnancy and is safe and well tolerated by both mothers and infants.

Findings presented at the Liver Congress 2015 suggest patients with both Hepatitis B and Hepatitis C may experience more rapid and severe liver disease progression than those with Hepatitis B alone, though infection with both viruses does not appear to worsen Hepatitis C progression.

Other Hepatitis B updates

Incentives for completion of Hep B vaccination in OST patients

A cluster randomised trial published in the Lancet has shown that modest financial incentives significantly improves adherence to and completion of Hepatitis B vaccination programmes in patients receiving opioid substitution therapy.

Rheumatoid arthritis reduces HBV vaccination effectiveness

A study presented at the European League Against Rheumatism Annual Congress has shown that people with rheumatoid arthritis are less likely to be protected by the Hepatitis B vaccination than the general population.

Vitamin D improves depression in women with liver disease

A study presented at the 12th World Congress of Biological Psychiatry has shown that women, although possibly not men, who have chronic liver disease with depression, experience significant improvement in depressive symptoms when treated with vitamin D therapy to correct underlying vitamin D deficiency.

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Spotlight on services: Positive Help Edinburgh

Scottish charity sees surge in demand for its services

Edinburgh charity HIV and Hepatitis C charity Positive Help has seen a 25% increase in demand for it's services in the past year, which it's Chair says is down to increased pressure on statutory services, people living with HIV for longer and changes to the welfare system.

They are urgently seeking extra volunteers to support their work. If you are interested in volunteering visit their website.

Ireland can C it too

One of the Big Red C's from the Scottish World Hepatitis Day campaign has now made its way to Ireland, turned green, and is currently taking a major role in the Irish national campaign.